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Ever increasing PSA levels.

User
Posted 19 November 2017 08:59:56(UTC)

Hello,

First time here, as I'm concerned (and confused) by my PSA levels.

I am now 60 and have been monitored for 3 years by my GP and urologist, following an initial concern over groin pain (which may actually have been the result of a high intensity cycle exercise). This led to an initial PSA test of low 4's which was considered high but DRE examinations showed no physical abnormalities and due there being no other symptoms the recommendation was to continue with 6 monthly PSA checks. These remained around this level for about 18 months (sometimes up a little, sometimes down) but since then there has been a steady rise in my readings.

Since the levels starting increasing, my Urologist recommended 3 monthly tests. Along with this I have had numerous DRE examinations, an MRI scan, Ultrasound scan and finally a CPA3 test (privately). All of these have not shown any abnormalities and the CPA3 test was negative (3 on a threshold of 25). I went down the CPA3 route, rather than the biopsy route as my research led me to believe that it was a more reliable test than the biopsy (plus it was non invasive).

The ultra sound scan showed my prostate was enlarged  (60cc) but other than that I do not have any other physical symptoms, I do not need to pee at night, my flow rate is generally good (it can be a little variable sometimes but not often) and I empty my bladder when required. No other symptoms, such as back/groin pain, fatigue or constipation are present. My health is generally good, I exercise as much as possible and I'm not over weight, my diet is as healthy as possible and I drink in moderation too.

And yet, for the last 18 months my PSA readings have been on the rise with the latest reading at 11.9.

Obviously this has come as a blow, as following the negative CPA3 reading the private consultant told me to expect my PSA levels to drop.

A biopsy now seems to be the only option but should I wait until my next appointment with the Urologist in April or push for something sooner?

 

User
Posted 20 November 2017 16:51:12(UTC)

Davwalt, you lucky man, you can relax and get on with your life. You don't have PCa but getting your prostate a tad smaller may make things more comfortable. I presume you are being offered treatment for this?

AC

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User
Posted 19 November 2017 09:17:33(UTC)

Hello misterb_57 and welcome.

I don't have the necessary knowledge to advise you but others will (weekends tend to be quieter so you might have to wait for a reply).

Two things strike me

a) Have you been checked for infection?


b) You are obviously a keen cyclist and it is thought that cycling can raise a PSA level, especially if you cycle just before the test

    (and so can sexual intercourse just before the blood test)

c) Benign Prostatic Hyperplasia (enlarged prostate and you say yours is large at 60cc) can cause a raised PSA

Best Wishes
Sandra

We can't control the winds - but we can adjust our sails
User
Posted 19 November 2017 10:05:34(UTC)

Originally Posted by: Online Community Member
PSA readings have been on the rise with the latest reading at 11.9  ... consultant told me to expect my PSA levels to drop. A biopsy now seems to be the only option but should I wait until my next appointment with the Urologist in April or push for something sooner?

Certainly sounds like a biopsy is the logical next step. While I suspect the risk of waiting a few months is probably small, peace of mind is important too. And the whole business has been 3 years - which is long enough to wait for a bit of certainty.

I'd push for a referral now.

Good Luck!

.

-- Andrew --

"I intend to live forever, or die trying" - Groucho Marx
User
Posted 19 November 2017 10:16:30(UTC)

Each of the tests taken in isolation could provide a false negative but taken all together, are strongly indicative that your rising PSA is benign. With a large prostate volume, clear scans and such a low CPA3 (PCA3) score, it is hard to imagine that a TRUS biopsy is going to find anything and there is no suspect area to target in a template biopsy. BPH or PIN can result in a PSA much higher than you are currently recording and as Johsan says, prostatitis is a difficult infection to diagnose. We have had men with PSA 5 or 6 times higher than yours for whom no cancer was found.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 19 November 2017 12:41:16(UTC)

my psa s over 18 mths have been 5.2   then 8.0

had biopsies all negative

i have a very large prostate  68 cc

uro stated mine is BPH

had a follow up psa blood test 3 weeks ago

and have uro appointment tomorrow (monday) to receive the results

fingers crossed

 

User
Posted 19 November 2017 17:05:07(UTC)

Assuming an infection has been correctly ruled out, it is possible that the PSA could be down to a combination of things, including BPH, sex or cycling within a day or two of the blood test.

In your shoes I would make sure I did not do any of the things that could inflate my next PSA figure and if this still shows an increase ask urologist if I could have an MRI scan to see whether this showed anything suspicious and then have a biopsy. But how you proceed is for you to decide.

Barry
User
Posted 19 November 2017 23:01:43(UTC)

Thanks for all your replies so far and apologies for the typo (PCA3 of course).

I'm afraid I'm not a keen cyclist (the bike is buried at the back of the shed, as I think the roads are too dangerous/crowded these days) - it was just a phase on an exercise bike and hence why looking back, I think it caused the groin strain.

Also, make sure I don't have any sexual activity prior to the PSA tests.

Lynn, when you say "We have had men with PSA 5 or 6 times higher than yours for whom no cancer was found." - do I take it you are a health professional in this area?

User
Posted 19 November 2017 23:04:46(UTC)

Hi,

Some good replies above. 

How do they decide if it’s BPH, is it a biopsy.  If so perhaps it’s better to have one.   Or to ask what treatments they give someone with BPH or whatever and try them. 

A question could be whether to have a standard biopsy or a template biopsy.  With such a large prostate a standard one could easily miss but on the other hand it might find another reason for the high psa.

An MRI should be great evidence but it depends when you had it.

Cycling is unlikely to make such a difference to your psa.  Your diet and exercise similarly is only marginal evidence.

Sometimes your decisions are made by the amount of concern you have, some people are willing to take more of a chance or to avoid taking the action that could be better for them. 

I think I'd ask what they do for BPH,  then likely go for the biopsy.  Perhaps ask for another MRI but not sure about that.

Hope that is of some help and you sort it out. 

Regards 

 

I’m only a patient and not qualified to advise.

User
Posted 19 November 2017 23:47:23(UTC)

Measurements and weight of prostate calculated from scans.

A Prostate grows as a man ages but more in some men than others.

If the enlargement is so much that it causes a problem, it can be treated in a number of ways. This Mayo link covers these. https://www.mayoclinic.o...s/treatment/con-20030812

Barry
User
Posted 20 November 2017 07:58:14(UTC)
Originally Posted by: Online Community Member

Lynn, when you say "We have had men with PSA 5 or 6 times higher than yours for whom no cancer was found." - do I take it you are a health professional in this area?



Sorry no, I meant 'we' the forum members have seen men join with PSA of 50, 60 or even higher but then get the all clear and leave us again. You may find one or two of the more recent examples by scrolling through the new members section.

I don't think any of the current active members are medical professionals and if they were, they would be unlikely to disclose that on a public forum. I think there are a few nurse specialists who read but don't post and we used to have a member who was a GP but he isn't active these days.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


User
Posted 20 November 2017 11:45:33(UTC)

Originally Posted by: Online Community Member

my psa s over 18 mths have been 5.2   then 8.0

had biopsies all negative

i have a very large prostate  68 cc

uro stated mine is BPH

had a follow up psa blood test 3 weeks ago

and have uro appointment tomorrow (monday) to receive the results

fingers crossed

 

 

follow up appointment with urologist this morning (monday)

PSA results 7.2   a drop from 8.0

programmed in for PSA retest in 6 mths

although it is down slightly, uro is not concerned due to my BPH

he has suggested regular PSA tests, and if it starts to rise he will want to see me again

he suggested that he would not be concerned until PSA reaches 15

User
Posted 20 November 2017 16:51:12(UTC)

Davwalt, you lucky man, you can relax and get on with your life. You don't have PCa but getting your prostate a tad smaller may make things more comfortable. I presume you are being offered treatment for this?

AC

Thanked 1 time
User
Posted 20 November 2017 17:39:40(UTC)

Originally Posted by: Online Community Member

Davwalt, you lucky man, you can relax and get on with your life. You don't have PCa but getting your prostate a tad smaller may make things more comfortable. I presume you are being offered treatment for this?

AC

 

 

no treatment not required at this stage

i am following ''manageing my symtoms'' now i know what it is

like no drinks late at night, etc etc

If it becomes a problem uro  has told me he can prescribe medication to reduce the size of my prostate

BUT the medication does mask and give a false PSA reading, so in a sense i am better keeping off medication as long as possible

 

 

 

 
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